Evaluation of a quality improvement intervention for obstetric and neonatal care in selected public health facilities across six states of India

BMC Pregnancy and Childbirth

Research Article

Enisha Sarin¹  Rachana Patel²  Subir K. Kole³  Sanchit Kharwal⁴  Rashmi Singh⁵  Nigel Livesley⁶  Mirwais Rahimzai⁷  Ankur Sooden⁸ 

[1] Consultant, University Research Company, India Pvt. Ltd B7, 1st floor, 122002, Suncity, Gurgaon, Haryana, India;Consultant, University Research Company, India Pvt. Ltd. E 5, NTRO scientist Hostel, Behind Sahastra Seema Bal, 110047, Aya Nagar, Delhi, India;Data Manager, University Research Company, India Pvt. Ltd, T8-502 Amrapali Grand Sector Zeta 1, 201306, Greater Noida, UP, India;Doctoral Fellow (Social Epidemiology), Humanities and Social Sciences Discipline, Indian Institute of Technology, Gandhinagar, India;Lead- Quality and Process Improvement, ACCESS Health International, Nilgiri building, IIIT, Gachibowli, Hyderabad, India;Project Director, University Research Company, 1st floor, LMR House, S-16, Uphaar Commercial Complex, Green Park Extension, 110016, New Delhi, India;Project Director, University Research Company, Plot 40, Ntinda II Road, Kampala, Uganda;Senior Advisor, University Research Company, 1st floor, LMR House, S-16, Uphaar Commercial Complex, Green Park Extension, 110016, New Delhi, India;

关键词: Quality improvement;    Obstetric care;    Neonatal care;    Health care delivery;    Health system strengthening;    India;   

DOI  :  10.1186/s12884-017-1318-4

 received in 2016-12-27, accepted in 2017-04-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWhile increase in the number of women delivering in health facilities has been rapid, the quality of obstetric and neonatal care continues to be poor in India, contributing to high maternal and neonatal mortality.MethodsThe USAID ASSIST Project supported health workers in 125 public health facilities (delivering approximately 180,000 babies per year) across six states to use quality improvement (QI) approaches to provide better care to women and babies before, during and immediately after delivery. As part of this intervention, each month, health workers recorded data related to nine elements of routine care alongside data on perinatal mortality. We aggregated facility level data and conducted segmented regression to analyse the effect of the intervention over time.ResultsCare improved to 90–99% significantly (p < 0.001) for eight of the nine process elements. A significant (p < 0.001) positive change of 30–70% points was observed during post intervention for all the indicators and 3–17% points month-to-month progress shown from the segmented results. Perinatal mortality declined from 26.7 to 22.9 deaths/1000 live births (p < 0.01) over time, however, it is not clear that the intervention had any significant effect on it.ConclusionThese results demonstrate the effectiveness of QI approaches in improving provision of routine care, yet these approaches are underused in the Indian health system. We discuss the implications of this for policy makers.

【 授权许可】

CC BY   
© The Author(s). 2017